4734 Penkwe Cir - Inspection Form4. 11 _ 11111. City of Cap,aq
Residential Sanitary Sewer Service
Compliance Inspection
Date)//•LZ J1
-
Name )
717
At
C
4" to 6" Transition:
White Copy: Property Owner
3
Time
Disk # LIE
PID Number
House Number . Street Name
Alternative Mailing Address
Owner/Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
\
0 Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
am
Pm
Damaged Pipe
Transition
For information call 651.470.2788
Non-Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
Phone .4
Obstruction
Unable to push past
feet.
Entered S.L at
inspii Signature
Roots
Poor Pipejoints
Mineral Deposits
Sag/Pipe Deflection
Final Cleanout:
am
•
• 0 pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
I 1
•,:". " 1 ) . 1
,-- ----- 1- --7---- ,-;: "
)
/ )
- .)
Total
Sump pumps
-4 1__
/.,_._ .."-
// e'
("?.---- .1
/
:-,..-- f ...-' " l
Foundation drains
Roof drains
,(21
_...,
\/
A,-
4. 11 _ 11111. City of Cap,aq
Residential Sanitary Sewer Service
Compliance Inspection
Date)//•LZ J1
-
Name )
717
At
C
4" to 6" Transition:
White Copy: Property Owner
3
Time
Disk # LIE
PID Number
House Number . Street Name
Alternative Mailing Address
Owner/Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
\
0 Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
am
Pm
Damaged Pipe
Transition
For information call 651.470.2788
Non-Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
Phone .4
Obstruction
Unable to push past
feet.
Entered S.L at
inspii Signature
Roots
Poor Pipejoints
Mineral Deposits
Sag/Pipe Deflection
Final Cleanout:
am
•
• 0 pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH